폐기능 검사에 의한 소아 천식의 진행 및 기도 염증의 평가
Asthma Progression and Airway Inflammation Assessed by Lung Function in Children with Asthma
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목 적 : 천식은 소아 청소년기에 흔한 만성 기도 질환으로서 전 세계적인 보건사회 문제의 초래와 경제사회적인 부담을 가중시키고 있다. 현재 천식 치료가 기도염증과 기관지 과민성(airway hyperresponsiveness)의 효과적인 완화와 증상 예방에 주안점을 두고 있기는 하지만, 일부 환자들은 어려서부터 폐기능의 점진적 감소가 있고 성인기까지 증상이 지속된다. 따라서 치료와 예방을 위하여 이러한 소아기 천식의 진행과 지속에 관여하는 위험 인자들의 확인이 필요하다. 본 연구는 영아기부터 청소년기에 걸쳐 천식의 진행과 지속에 관여하는 위험인자를 찾아내어 치료에 도움이 되고자 하였다. 방 법 : 천식의 진행과 지속에 관여하는 위험 인자를 알아보기 위하여 경증-중등증 천식을 앓는 환아 67명을 대상으로 하였다. 곧, 3세 미만 발병 28예를 조기 발병 군으로, 3세 이후 발병 39예를 후기 발병 군으로 각각 분류하였다. 이들을 대상으로 아토피 병력과 가족력, 모유수유 기간, 부모 중 흡연 경력, 흡입용 코티코스테로이드(corticosteroid) 사용 경력과 폐기능 검사, 체질량 지수, 피부단자시험, 혈청 총 IgE 및 알레르겐 특이 IgE치, 말초혈액 호산구 수와 혈청 ECP 측정 등 검사실 검사 그리고 모든 환자에서 메타콜린 흡입 흡입과 자유 운동에 의한 기관지유발 시험을 각각 시행하였다. 결 과 : 천식 발생의 위험인자로서 아토피피부염과 잦은 천명의 빈도가 후기 발병 군 보다 조기 발병 군에서 유의하게 많았다.(P<0.05) 그러나 기관지유발시험에 따른 기관지 과민성의 빈도와 PC20 및 운동유발시험 후 FEV1 감소치는 두 군 사이에 유의한 차이가 없었지만,(P>0.05) 흡입용 코티코스테로이드 사용의 빈도는 후기 발병 군보다 조기 발병 군에서 유의하게 더 흔하였다.(P< 0.0001) 한편, 천식의 지속 기간과 FEV1/FVC 사이에 역 상관관계를 나타내었다.(r=-0.376, P= 0.004) 결 론 : 아토피피부염과 재발성 천명은 천식의 발생과 지속에 중요한 위험인자로서 평가 될 수 있을 것으로 생각된다.
Abstract
Purpose : The social and economic impact of asthma is remarkable worldwide. To date, there have been many unanswered questions about factors related to asthma progression and persistence. This study focused on possible risk factors for persistent asthma that had developed between infancy and late childhood. Methods : Sixty-seven children with persistent mild-to-moderate asthma were enrolled in this study. They were classified into 2 groups according to the Global Initiative for Asthma (GINA) guideline 2006 : early-onset (＜3 years, n=28) and late-onset (＞3 years, n=39) asthmatics. All patients were interviewed on the personal and familial history of atopy, breast feeding, parental smoking and the recent use of inhaled corticosteroids. We performed spirometry, and skin prick tests and measured body mass index, serum allergen-specific IgE, serum eosinophil counts and serum ECP in asthmatics. All asthmatics underwent the bronchial challenge by methacholine inhalation and outdoor free running. Results : Risk factors such as eczema and frequent wheezing were more common in early-onset asthmatics than in late-onset asthmatics (P<0.05). However, there was no difference between the 2 groups in the overall incidence of airway hyperresponsiveness (AHR) determined by the PC20 and postexercise decrease of FEV1 (P>0.05). Inhaled corticosteroids were more frequently used in early-onset asthmatics than in late-onset asthmatics (P<0.0001). A reciprocal relationship between FEV1/FVC and the duration of asthma was also detected in persistent asthmatics (n=57, r=-0.398, P=0.002). Conclusion : The results of this study suggest that atopic dermatitis and frequent wheezing may be important risk factors for the persistence of asthma and lung function decline from early to late childhood.
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